Peritoneal Tuberculosis With Septated Fluid Collection: A Case Highlighting the Value of Persistent Diagnostic Efforts

Peritoneal tuberculosis (TB) is an uncommon form of extrapulmonary TB that often presents with nonspecific symptoms, making early diagnosis challenging. Delayed recognition can lead to complications, emphasizing the need for timely identification and treatment. We describe the case of a 25-year-old man who presented with a two-week history of fever and abdominal discomfort. His symptoms included intermittent fever with an evening rise, chills, and unexplained weight loss. He had no prior TB history or known exposures. Initial investigations raised suspicion of a viral or enteric infection, particularly after a positive rhinovirus test. Despite empirical antibiotic therapy, his fever persisted. Imaging revealed complex fluid collections in the abdomen, prompting further evaluation. The first set of microbiological tests, including AFB smears and PCR for <i>Mycobacterium tuberculosis</i>, was negative. However, due to high clinical suspicion, repeat PCR testing ultimately confirmed peritoneal TB. Anti-tubercular therapy was initiated, resulting in rapid clinical improvement. This case highlights the diagnostic complexity of peritoneal TB, mainly when initial microbiological tests are inconclusive. Strong clinical suspicion, repeat testing, and targeted imaging play crucial roles in achieving timely diagnosis and initiating appropriate treatment.